Journal of medical imaging and radiation oncology
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J Med Imaging Radiat Oncol · Dec 2008
ReviewDifferential diagnosis of T2 hyperintense spinal cord lesions: Part A.
Hyperintense spinal cord signal on T2-weighted images is seen in a wide-ranging variety of spinal cord processes including; simple MR artefacts, congenital anomalies and most disease categories. Characterization of the abnormal areas of T2 signal as well as their appearance on other MR imaging sequences, when combined with clinical context and laboratory investigations, will often allow a unique diagnosis, or at least aid in narrowing the differential diagnosis. A wide range of instructive cases is discussed here with review of the published reports focusing on pertinent MR features to aid in diagnosis.
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J Med Imaging Radiat Oncol · Oct 2008
Randomized Controlled TrialPatients' preference for radiotherapy fractionation schedule in the palliation of symptomatic unresectable lung cancer.
The palliative radiotherapeutic management of unresectable non-small-cell lung cancer is controversial, with various fractionation (Fx) schedules available. We aimed to determine patient's choice of Fx schedule after involvement in a decision-making process using a decision board. A decision board outlining the various advantages and disadvantages apparent in the Medical Research Council study of Fx schedules (17 Gy in two fractions vs 39 Gy in 13 fractions) was discussed with patients who met Medical Research Council eligibility criteria. ⋯ The decision board was useful in aiding decision-making, with both Fx schedules being acceptable to patients. Interestingly, despite the longer average survival associated with longer Fx, nearly half of the patients believed that this was not as important as a shorter duration of treatment and lower cost. Despite patients' preferences, there were significant alterations of preferred schedules because of RO's own biases.
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A review of MRI findings in seven patients with Tolosa-Hunt syndrome was carried out. Seven patients presented with unilateral painful ophthalmoplegia. Magnetic resonance imaging studies were carried out to evaluate the cavernous sinuses and orbits. ⋯ One patient had a relapse of symptoms after discontinuing therapy. Magnetic resonance imaging studies of the cavernous sinus and orbital apex show high sensitivity for the detection and follow up of inflammatory mass lesions in Tolosa-Hunt syndrome. Magnetic resonance imaging should be the initial screening study in these patients.
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J Med Imaging Radiat Oncol · Oct 2008
Clinical TrialRetrievable Gunther Tulip inferior vena cava filter: experience in 317 patients.
The aim of our study was to assess our experience with the retrievable Gunther Tulip (GT) inferior vena cava (IVC) filter, with regard to its insertion, efficacy, ease of placement and retrieval, and associated complications. Between November 2001 and October 2005, 322 GT filters were placed in 317 patients. Insertion indications included the following: pulmonary embolus (PE) prophylaxis in trauma patients (n = 232), PE prophylaxis in perioperative patients (n = 27), PE prophylaxis in moribund intensive care unit patients (n = 22), recent PE (n = 48), extensive deep venous thrombosis (n = 66), contraindication to anticoagulation (n = 63), anticoagulation complication (n = 8) and deep venous thrombosis with failed anticoagulation (n = 8). ⋯ The mean time from filter insertion to attempted retrieval was 76.95 days. The ideal filter implantation time gives the patient the benefit of PE protection, while avoiding the long-term risks associated with caval filters. Although GT retrieval times have lengthened considerably, our data suggest that this is at the expense of successful retrieval rates.
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J Med Imaging Radiat Oncol · Aug 2008
ReviewNephrogenic systemic fibrosis and the role of gadolinium contrast media.
Nephrogenic system fibrosis is a rare disease affecting patients with severe renal insufficiency or dialysis. Its aetiology is incompletely understood. Evidence is growing that gadolinium contrast media is a major risk factor, whereby risk increases with larger cumulative doses. ⋯ The EMEA differentiates between agents and advises avoidance of only gadodiamide and gadopentetate in the same patient categories. Other gadolinium contrast media should only be used after careful consideration of risks versus benefits. Post-procedural haemodialysis is only indicated in patients on regular dialysis.